Association between menstrual disturbances and habitual use of caffeine

The main objective of this study was to determine whether there is an association between drinking caffeinated beverages and menstruation among Saudi female students. During the 2011 academic year, a cross-sectional study was conducted by administering a questionnaire about menstruation and self-reported habitual use of caffeinated food or drinks to 350 premenopausal women with no known medical disease who were working or studying at the University. Odds ratios [ORs] and 95% confidence intervals [CIs] were calculated by chi-squared cross-tabulation. All tests were two tailed, and results were considered significant when p < 0.05. Irregular periods were reported by 140 women [40%], amenorrhoea by 26%, oligomenorrhoea by 20.9%, heavy periods by 13.4% and prolonged periods by 9.7%. Few women [7.7%] reported a previous diagnosis of polycystic ovary disease. Coffee was a risk factor for both prolonged periods [OR, 2.37; 95% CI, 1.09-5.12;p = 0.03] and oligomenorrhoea [1.95; 1.15-3.30; p = 0.014]. Nescafe was a risk factor for heavy periods [2.22; 1.91-4.12; p = 0.011] and menstrual symptoms [1.84; 1.06-3.02; p = 0.039]. Chocolate was protective against premenstrual symptoms [0.22; 0.06-0.85; p = 0.049]. There is a high prevalence of undiagnosed menstrual disturbances among Saudi university women. Habitual use of caffeine should be considered a risk factor for most menstrual abnormalities

Fungal sinusitis with intracranial extension in immuno-competent patients: surgical planning according to relation to eloquent neurovascular structures

To evaluate the results of combined neurosurgical and ENT surgical management for patients with fungal sinusitis with intracranial extension. We managed 10 cases with fungal sinusitis with intracranial extension. This included 7 females and 3 males. Four patients presented with unilateral proptosis, 2 with deterioration of level of consciousness due to meningitis, 2 with chronic headache, one with epilepsy and one patient presented with trigeminal pain. All cases had long history of chronic headache and nasal obstruction. CT was done in all cases, MR in 8 patients, CT angiography and conventional cerebral angiography in one patient. Surgical intervention was decided according to the relation of the fungal granuloma to eloquent intracranial structures. Endonasal approach alone was used when the granuloma was not related to the optic nerve, internal carotid artery or cavernous sinus [n=3]. Combined subfrontal and endonasal approach was used when the granuloma was closely related to one or more of these structures [n=5]. Transcranial approach alone was done for 2 patients with isolated sphenoid fungal sinusitis that was associated with a mycotic internal carotid artery aneurysm in one patient and with a temporal lobe abscess in the other. In addition, antifungal treatment was used for 8-12 weeks. Patients were followed up clinically and radiologically for 6-36 month period. No morbidity related to the operative procedures was recorded in the study group. One patient died two month post-operatively due to fungal meningitis. In survivors [n=9]: headache and nasal obstruction improved, proptosis was corrected, epilepsy and trigeminal pain were controlled by medication. Follow-up CT showed eradication of the fungal granuloma in all survivors. Histopathological results showed mucormycosis [n=2], aspirgillosis [n=4], and no fungus [4 patients. Team work by ENT and neurosurgical staff and early diagnosis are mandatory in the management of fungal sinusitis with intracranial extension in immune-competent patients. Surgical planning according to the relation of fungal granuloma to eloquent neurovascular structures is the cornerstone for save removal of granuloma

Tracheostomy experience in Al Noor Specialist Hospital retrospective 8 years experience from Feb. 1994 to Feb. 2002 [1414H to 1422H]

To review our Tracheostomy experience regarding indications, age and sex incidences, discuss complication rate and comparing it with international and national similar studies. ENT, ICU, ER, MICU [Minimal Intensive Care Unit] Neurosurgical and pediatric departments in Al-Noor Specialist [Tertiary teaching center], state of Makkah, Saudi Arabia. Out of 435 tracheotomies patients 380 [87.4%] operations done as elective procedure, 55 patients [12.6%] Emergency tracheostomies.122 patients [28.0%] were female and 313 [72.0%]were male patients, with 2.6:lmale to female ratio. Paediatric patients were 55 patients [12.6%]; adults were 380 patients [87.4%]. Saudi patients were 178 [41%] and Non-Saudi patients 256 [59%] out of these Resident patients were l40 [32%] and Non-Residents [pilgrim] patients were 117 [27%]. Overall complication rate is 27.6%[120 patients], of these 3 patients [0.7%] pneumothrox, 15 patients [4.3%] had hemorrhage out of these 4 patients [0.9%] had massive hemorrhage, 25 patients[5.7%] suffered from apnea, 3 patients [0.7%] developed cardiac arrest, 8 patients [1.8%] with cricoids cartilage damage, 20 patients [4.8%] had T. tube dislodgment, 10 patients [2.3%] developed surgical emphysema, 15 patients [3.4%] had peristomal infection, 1 patient [0.2%] had tracheal necrosis, 4 patients [0.9%] developed tracheo-esophegeal fistula, 10 patients [2.3%] developed subglottic stenosis, 5 patients [1.1%] had difficult decannulation, 2 patients [0.5%]developed tracheo-cutaneous fistula 51%of tracheostomies were due to surgical reason, 165 patients [38%] had neurosurgical indications out of these 142 patients [86%] head injuries.33 patients [7.6%] had ENT indications,9 patients [2%] Maxillofacial indications, 15 patients [3.4%]general surgery indications, 2 patients [0.5%] vascular surgery indications. Non surgical [medical] indications represented 49% [213 cases] commonest indication was respiratory diorders22.5% [98 cases], followed by neurological disorders 12% [53 cases], cardiac disorders 11 .5%[50 cases], general medical disorders 1.4% [6 cases] and nephrology disorders 1 .4%[6 cases]. Although our tracheostomy experience is comparable to the similar national and international studies with lower complication rate specially certain complications, still tracheostomy carries significant morbidity specially in makkah during Hajj season where more than 2 million pilgrims from outside Saudi Arabia gathers in Makka with different diseases back grounds it can be minimized by improving the health service, education, surgical skills, preoperative and postoperative care